One of the activities of PHCPI in Basra has been to strengthen the referral system between the primary and secondary levels of care. Since 2011, following implementation of a new referral system, the Basra Directorate of Health (DOH) is reporting more people have been visiting the PHC clinics for routine services, instead of going directly to the hospitals. This reduces the workloads of the provincial-level hospitals, and allows them to focus on the more specialized cases referred to them. Basra Governorate has 121 total PHCCs, 15 of which have been targeted by the USAID PHCPI project to date.